Like our casual life, medicine is shaped by social media, quick information exchange and so-called “influencers.” Gluten intolerance (distinct from celiac disease), chronic Lyme disease and fibromyalgia are common afflictions that can be researched on the internet. Every year, people discover a new illness and draw attention to its vague symptoms, which they feel have been forgotten or overlooked by physicians for decades. Patients previously suffering from nonspecific symptoms without any diagnosis find solace in the offered illness and thereby gain a diagnosis. “My suffering was not imaginary. It was real!” can oftentimes be heard on television.
I do not doubt the existence of these illnesses but I do doubt their prevalence in the population. The immense media coverage and popular interest that surround this may be based on more than just a financial benefit.
Few people, whether doctors, politicians or street cleaners, tend to acknowledge internal conflicts. This is a way to protect the ego and self-esteem from a perceived threat. The idea that an internal conflict or negative emotion can cause a functional symptom is referred to as “gain of illness” or “morbid gain.” It allows us to shift our attention from a threatening entity to a common or non-threatening one. This entity is a means for us to receive attention and compassion, but also to avoid unpleasant emotional conflict and thereby provide an external benefit. To put it simply, the concept refers to the rise of functional symptoms due to emotional and internal distress
I would suggest that patients’ temptation to be diagnosed with the aforementioned popular illnesses is morbid gain. More specifically, it is a search to label this gain to legitimize what they are experiencing, which leads to a gain of diagnosis. Through identifying with the illness, the patient benefits from an internal sense of validation.
While there are plenty of names for functional symptoms and states of distress, they are not widely known to the public. These conditions are often stigmatized by families, friends and even doctors. We depend on names and words to provide structure. The idea of structuralism even goes so far as to argue that language acts as an overarching system which enables us to understand culture and other humans.
The core idea of this philosophy seems obvious to us, yet we forget about it on a regular basis. Names and terms give us a sense of belonging. Our family name forms identity. In Arabic, the prefix “Abu” — meaning “father of” — signifies status within a family as well as society. Meanwhile, in many Western societies the tradition of giving the first-born son his father’s name illustrates the importance of our names and the relationship we form with the world. Our world and even the world of medicine are formed by language. A house is a house, a cat is a cat, and cancer is cancer.
Nameless entities, on the other hand, are fearsome and cause anxiety. What we cannot signify seems alien to us. The ambiguity produces fear.
A disease may cause short-term and long-term anxiety. Like our patients, we as doctors want a name for every disease.
When we are faced with distress, the sympathetic nervous system, with its fight-or-flight response, is activated and acts on other body systems. ACTH triggers cortisol release, which decreases our metabolism and weakens the immune system. This is the wonderful approach our bodies take in acute situations: more power for our muscles and less energy wasted on other systems. But what happens if our minds are not in acute stress but are rather in constant distress? Our bodies ache and our muscles experience pain. We have gastrointestinal problems and depressive symptoms like sleeplessness. This leads to a vicious cycle of continued stress and anxiety. The patient becomes even more uncertain about his or her condition.
The constant stress reaction leads to the manifestation of somatoform disease. What seems to come from nowhere and seems made-up is based on physiology and is, in fact, a real illness.
I would argue that most of the “self-proclaimed” diseases like gluten intolerance and chronic Lyme disease are misdiagnosed somatoform illnesses. This is not out of stupidity or willful ignorance as many doctors believe, but as a strategy to decrease distress.
Psychosomatic illness arises from emotions and from internal conflicts, both of which are unconscious yet strive to become conscious by forming symptoms. Psychosomatic medicine is frightening but what makes it even scarier is its namelessness among the public.
Is it possible to change these views and give patients the correct name of a disease instead of a generic diagnosis? From my point of view, four things should be done. Firstly, we doctors need to establish a genuine relationship with the patient. This relationship must be without ridicule and involve actively listening to the patient’s complaints and his or her unique burden of suffering. Secondly, we should explain the meaning of psychosomatics and help the patient to understand the illness. A simple phrase could be, “Psychosomatics is the branch of medicine which deals with relationships and internal conflicts that cause physical, social and emotional problems.” Thirdly, we should show that the need for treatment is not a weakness, but rather an opportunity to face one’s personal and unique suffering. Lastly, we should not dismiss psychotherapy. After all, uncovering one’s conflicts, which were hidden for a good reason, can be traumatizing.
In this way, doctors can offer patients a more useful instrument to deal with the fear-laden nameless disease rather than an inadequate treatment for an illness that has a name.